- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,664.22 / $13,082.50 / $21,264.60
| Facility | | $7,664.22 | $13,082.50 | $21,264.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,177.00 / $11,177.00 / $11,177.00
| Facility | | $11,177.00 | $11,177.00 | $11,177.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,572.02 / $10,394.70 / $16,398.66
| Facility | | $6,572.02 | $10,394.70 | $16,398.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,413.70 / $8,061.90 / $16,538.64
| Facility | | $3,413.70 | $8,061.90 | $16,538.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,164.00 / $11,008.60 / $14,950.56
| Facility | | $6,164.00 | $11,008.60 | $14,950.56 |